Hospice and home health provider Amedisys (NASDAQ: AMED) has been combating employee turnover amid ongoing industry-wide staffing shortages. Hospices nationwide have seen turnover rise during the pandemic even as they work to meet rising demand.
Slightly more than 20% of health care workers have considered leaving the field due to stress brought on by the pandemic, and 30% have considered reducing their hours, according to a recent study publishing in JAMA Network Open. More than 35% of hospice leaders surveyed by Hospice News earlier this year cited staffing shortages as a top concern for their organizations, along with regaining access to patients in facilities.
“It’s gonna be a supply issue. We saw what’s ahead on the road, which is if we don’t have the excellent and productive clinical staff we don’t think we’ll be able to post the growth that we’re anticipating for the next five years,” Amedisys CEO Paul Kusserow said during an earnings call. “That’s why we’re so focused on turnover.”
These concerns have made recruitment and retention a top priority at Amedisys, and the company is seeing positive results. Turnover is down among hospice and home health employees despite the challenges brought on by the pandemic.
The company’s total voluntary turnover rate dropped to 15.9% in the first quarter of 2021, down from 19.5% in 2020. Among the initiatives Amedisys is pursuing is the recent implementation of a data analytics system that predicts with 80% accuracy whether an employee may be leaving their position, allowing opportunities for intervention.
“Keeping our people and helping them develop and grow is our next great challenge. It takes time and effort to recruit our clinical staff who are in higher demand than ever,” Chief Operating Officer Chris Gerard said. “We saw reductions in clinical turnover nearly across the board in both home health and hospice and saw reductions in care center leadership turnover in both lines of business.”
Amedisys earned more than $537 million in revenue during the first quarter of 2021, up from nearly $491.7 million in Q1 2020. The company’s hospice business accounted for $191.5 million in Q1, marking an increase from $169.4 million during the prior year’s quarter.
Amedisys’ experience during the pandemic mirrors what many organizations in the hospice space have encountered. The company has seen a rise in admissions during the pandemic, but a reduction in average daily census due to shorter lengths of stay. Median length of stay hit 18 days in January, compared to 27 days in the first month of last year.
The pandemic has led to a drop in referrals from nursing homes and assisted living facilities due to fears of spreading the virus. Those facilities have severely limited access to their patients and residents during the outbreak and have also seen lower volume of resident move-ins.
Generally, patients in nursing homes and assisted living tend to see longer lengths of stay than individuals referred by other providers such as hospitals and physician practices. Hospice providers, including Amedisys, have also seen drops in the number of hospital referrals due to lower utilization. Many patients have postponed surgeries and other high acuity care during the pandemic.
During the fourth quarter of 2020, Amedisys had 15% growth in admissions but no improvement on average daily census. However, referrals from traditional institutional sources are starting to rebound, even as providers continue to see rising numbers of referrals from physician offices.
“The metrics we’re watching very closely are our median length-of-stay and our percent of patients that are on service for 14 days or less,” Gerard said. “The good news is as you move through Q1 [2021], both of those numbers moved in a positive direction at a pace a little quicker than what we had in our internal models.”
Amedisys’ hospital referrals are once again approaching pre-pandemic levels, Kusserow indicated. Recovery in their skilled nursing and assisted living numbers has been slower but is likely to accelerate as the year progresses and more residents of those facilities become vaccinated. Skilled nursing and senior living historically have accounted for about 18% of the company’s admissions.
Last month Amedisys’ average daily census returned to levels seen the previous March, just as the pandemic was starting to heat up, according to Kusserow.
Amedisys has also benefited from the temporary suspension of Medicare payment sequestration during the COVID-19 public health emergency. Congress recently passed legislation to extend that moratorium until Dec. 31.
Sequestration was established in 2014 by the Budget Control Act. The practice reduced payments to hospice and other health care providers by 2% across the board. The company raised its 2021 guidance by $27 million to reflect the extension.
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